ABSTRACT. Pharmaceutical advertising is one ofthe most important kinds of advertising that can havea direct impact on the health of a consumer. Hence,this necessitates the fact that it is essential foradvertisers of such products to take special care andadditional responsibility when devising the promo-tional strategies of these products. In reality, it hasbeen observed that pharmaceutical product advertisersoften promoted their products to achieve their owngoals at the potential risk of having an adverse effecton the consumer’s health. This type of advertising ismost often seen in over-the-counter drug productadvertisements, and not as often in the case of pre-scription drug advertisements, which is relatively new.This article analyzes various purposes of advertisingpharmaceutical products and also the potentialproblems that arise from the way pharmaceuticalproducts have quite frequently been promoted.

KEY WORDS: advertisements, behavioral, compe-tition, consumerism, information source, nonpre-scription, prescription

Humans are described as creatures of habit. Wemay resent this characterization because it seemsto deny our individuality and free will. This isparticularly significant in a “free” society. To besure, much of what people do involves repeti-tive behaviors, usually the result of habits. Mostpeople sleep on the same side of the bed eachnight, sit in the same chair at the table, have thesame routine each morning, etc. These repetitivebehaviors are rarely questioned and simplybecome a part of our being.

Consumerism is characterized as an organizedmovement of citizens and governement agenciesto improve the rights and powers of buyers inrelation to the rights and powers of sellers (Kolterand Armstrong, 1997, pp. 568–570). Individuals,as well as populations, tend to exhibit certainpatterns when shopping. Quite often it has beenobserved that many individuals have similarpurchase habits and styles. Obviously, if manu-facturers and marketing personnel can identifythese habits and patterns, they can enhance sales.Motivational research can be a branch of mar-keting which involves psychologists and socialscientists in the discovery of human purchasingtrends and behaviors. In particular, it attemptsto discover the factors that motivate consumersto make certain purchases or to select certainservices.

In this article, the authors have made anattempt to discuss some of the potential problemsthat may arise with increased levels of pharma-ceutical product advertising. Some unethicalaspects of advertising this type of product directlyto consumers are also discussed. During theprocess of writing this article, authors wereunable to identify many literary works whichhave addressed this question of unethical phar-

Pharmaceutical Advertisements:

Ashish ChandraHow They Deceive Patients Gary A. Holt

Journal of Business Ethics

18: 359–366, 1999.© 1999 Kluwer Academic Publishers. Printed in the Netherlands.

Ashish Chandra is an Assistant Professor of Pharmacy andHealth Care Administration at Xavier University ofLouisiana, New Orleans, LA 70125. Dr. Chandra haspublished in several peer reviewed journals and proceed-ings in the fields of Business, Health CareAdministration, and Pharmacy Administration. He hasalso served as the Track Chair for the HealthCare/Health & Safety Track of the 1998 SouthwestAcademy of Management Conference and as the TrackChair for the Professional/Health Care/ServicesMarketing Track of the 1998 Southwestern MarketingAssociation Conference.

Gary A. Holt is an Associate Professor of PharmacyAdministration, Northeast Louisiana University,Monroe, LA 71209. Dr. Holt has also published exten-sively in the fields of Pharmacy and Health CareAdministration.

maceutical advertising despite an extensive liter-ature search conducted by them.

Advertising frequently reflects the discoveriesof motivational research as it applies to con-sumerism. This is particularly important in thecase of nonprescription, or over-the-counter(OTC), medications because consumers spendhundreds of millions of dollars each year on theirpurchase (Mayo Clinic – Use versus Abuse,1993). All together, Americans spend over 30billion dollars for medications and pharmaceu-tical products (Mayo Clinic – Medications andYou, 1993).

Nonprescription drugs have been directlyadvertised to consumers over various kinds ofmedia for several decades. After Boots Inc. firstbegan advertising Rufen® in 1983, the trend ofdirect-to-consumer-advertising has also includedthe advertising of prescription drug products(Shuler, 1984; Madhavan, 1993). Advertisers ofpharmaceutical products should not forget thefact that they are dealing with a product whichcan have a significant impact on a patient’s health.Thus, it is very important for pharmaceuticalproduct advertisers to understand that theAmerican public needs a higher quality of adver-tising from the pharmaceutical industry thanfrom automobile or detergent makers (Waldholz,1992). They should consider the morality of theirpromotional efforts first before they consider themonetary advantages of these efforts. This mightbe a difficult task because for most organizationshaving monetary gains is their way of survivingin the highly competitive environment ofbusiness. However, at the same time, pharma-ceutical product companies are not like mostother companies because most other companiesdo not deal with a product which directly affecthuman health.

Manufacturers may attempt to familiarize con-sumers with brand names in hopes that theconsumer will purchase a particular product. Theconsumer may think, “I’ve heard of thisproduct!” and assume that it is somehow betterthan competitive products. Most people are awareof the high advertising costs involved withproducts and it is possible that if they see aproduct being advertised extensively, they mightassume that the product is doing well in the

market and that is why the company has moneythat they can spend on advertising. In turn, thismay influence their purchase behavior towardsthis product, which is usually by the way of theirpurchasing this product. The consumer may evenpurchase the product as a result of impulsebuying. Especially with this latter possibility inmind, advertising frequently attempts to achieveno other purpose than to cause the consumer toremember the name of the product. Thus, theadvertisement may offer little useful information,but may instead depend upon humor or othertechniques which serve only to attract the viewerto the product name. Morris and Millstein foundthat the degree to which risk information iscommunicated to consumers via drug advertise-ments is related to the way the information isstructured in the advertisement (Morris andMillstein, 1984). Promotion efforts frequentlytarget certain segments of the population (e.g.,women and teenagers with smoking advertise-ments), or they may target consumer weaknesses(e.g., pain medications designed for headaches)to which most people can readily identify (MayoClinic – How Hazardous is Smoking, 1993).

Purposes of drug advertising

Competition

Typically, there are many manufacturers providingsimilar health care products and services. In orderto generate sales, manufacturers promote theadvantages of their products or services ascompared to their competitors. Thus, competi-tion tends to encourage manufacturers to incor-porate more “advantages” in their products orservices (i.e., “building a better mousetrap at alower cost”). Theoretically, this means that thequality of products and services will tend toincrease over time, and that costs may tend todecrease (at least in terms of cost/benefit con-sideration). Unfortunately, the “extras” which areadded may eventually become the “standard” bywhich the product or service is compared. Inturn, this can lead to an increase in cost asconsumers begin to demand these extra benefitsas a basic component. As manufacturers contin-

360 Ashish Chandra and Gary A. Holt

ually attempt to “undo” their competitors, costseventually tend to rise as marginal benefits arerealized (e.g., as a result of product developmentresearch) for relatively exorbitant costs. Productsand services may be “improved,” when in fact,no real improvements are necessary. Still, com-petition encourages new product and servicedevelopment and availability.

Consumer interests

As a result of competition, prices may tend toremain stable for longer time periods, even when“improvements” have been added. For theconsumer, this can provide for the availability ofgreater product selection at a more reasonablecost. At the very least, prices for similar productsand services tend to be similar, even when theyare high. However, the situation in the case ofdrug products is quite different. After a new drugmarketing exclusivity, or monopoly, over thedrug runs out, other companies can come outwith similar “generic” products. The marketingexclusivity awarded to a company for an orphandrug, a drug developed to treat rare diseases, isusually for seven year (Mathieu, 1990). Sincegeneric product manufacturers usually do notincur significant amount of Research andDevelopment expense for this drug product, asdid the primary company when they developedthis new drug entity, they are able to bring theirproducts in the market at a significantly lowerprice as compared to the original manufacturerof the brand name product. In this time and agewhen consumers are constantly trying to makeends meet with their limited income, most ofthem usually like to go for a generic drugproduct. However, at times, the significant dif-ferences in the prices of brand name product anda therapeutically similar generic drug productcreates a doubt in the mind of the consumerregarding the effectiveness potential of thegeneric drug product. Consumers, in such situ-ations, should get advice from pharmacistsregarding their drug product selection.

Economic contributions

Advertising is thought to contribute to theeconomy as well. By effectively promotingincrease in purchase and utilization of goods andservices may occur, which in turn can result inincrease in sales and the flow of money withinsociety. A recent example of economic contri-butions which consumers in many societies couldrecall would be the case of having a casino intheir city. In many cities and states in recent pastit was extensively promoted how the inclusion ofa casino in their society will have a positiveimpact on the society’s, city’s, or state’s economy.Casinos sure did have an impact on most society’seconomy, but the discussion regarding this matteris beyond the scope of this article. We are moreconcerned with the impact of pharmaceuticalproduct sales on the economy of a society.Recent times have also seen an increase in thenumber of mail order pharmacies. Many orga-nizations want their employees to buy pharma-ceutical products from these mail orderpharmacies. Though it has been observed thatmost mail order pharmacies have lower prices ascompared to the prices at local retail pharmaciesfor similar drug products, it is very difficult tojustify the economic contribution of these mailorder pharmacies in your society. Some justifi-cations that come to mind are that they areconvenient as the consumer gets it deliveredwhere they want to and also that it is cheaperwhich in turn relieves some monetary pressurefrom the consumer’s mind. This monetary savingcan then be spent by the consumer in thepurchase of other items in his or her society.

Information source

Through advertising, consumers can learn aboutnew products and services which are available tothem. If the advertisement is appropriatelywritten, then it can also help consumers learnabout proper selection and use of products andservices. Advertising tends to emphasize theadvantages of one product or service as comparedto another. Unfortunately, these “advantages” arefrequently more the product of hype than fact.

Pharmaceutical Advertisements 361

A new source of product informationbecoming popular very rapidly is the Internet.Internet is also becoming a popular media foradvertising drug products directly to consumers.Almost all major drug companies have their ownworld wide web site. Some people have visitedthese sites to get information regarding theproducts they have purchased. Consumers shouldbe warned here that most of the information theyget from a particular company may be biased oreven incomplete and they may not get all therelevant information regarding their drugproduct. They should also be cautioned thatthere are many places over the network whichmay provide wrong and misguided informationto consumers.

Manufacturing interests

The point of advertising is to generate sales ofproducts and services in order for the manufac-turer to remain economically viable and suc-cessful. This requires that the manufacturer mustinform the consumer regarding the availability ofproducts and services. Mass advertising canintroduce products and services to large numbersof consumers in a very short period of time. Fordrug products, large scale advertising will bebeneficial only to well established brand nameproduct pushers. Large scale advertising directlyto consumers is most likely not going to beeconomically feasible for generic drug manufac-turers as they usually market their productsdirectly to wholesalers, retailer, or chain stores.Once the retailer accepts the generic drugproduct for resale from its stores, then it isrepackaged usually using the retail store’s brandname, like Kmart has its own brand name on thegeneric products in its stores.

These are valid purposes, particularly regardingdrug advertising, even though they frequentlybecome distorted as a result of competition andpromotional practices of questionable ethics(Cope, 1976; Day 1976; Rheinstein, 1976).

Problems with drug product advertising

There are several written regulations that can beused as a guidance tool when it comes todeveloping advertising strategies. However, theserules do not cover all aspects that shouldbe considered, both from the marketers pointof view as well as from the patient’s point ofview. Fortunately, recent years have seen anincreased emphasis on marketing ethics andsocially responsible actions taken by several com-panies (Kotler and Armstrong, 1997, p. 92). Butthere still needs work to be done in order toimprove socially responsible marketing by manyorganizations.

Just as there are valid purposes for advertising,so too are the problems associated with adver-tising. A general problem associated with drugadvertisements is that it is a powerful influencewhich may motivate consumers to select overlyexpensive, overrated, or less than optimummedications for their particular needs. Morespecifically, it is possible to identify numerousindividual problems associated with the promo-tional practices. The most serious of these involveinformation problems (Griffenhagen, 1976;Rheinstein, 1976). As far as they go, advertise-ments tend to be truthful. However, they fre-quently omit information which the consumerneeds in order to make appropriate productselections. This is particularly interesting in thecase of pharmaceutical products considering thefact that there are more than 500,000 OTC drugproducts available in the U.S. (Mayo Clinic –Medications and You, 1993). For example,consider advertisements that claim that theirproducts contain “more pain reliever that doctorsrecommend most.” In fact, they do. Both “extra”strength aspirin and acetaminophen productscontain more of these ingredients than “regular”strength products. What the consumer is not toldis that this difference may not be clinicallysignificant (i.e., consumers may not perceive adifference between 650 mg and 1000 mg ofaspirin). Our culture very much believes in the“More is Better” principle (i.e., if one tablet willdo so much good . . . just think what 3 tabletswill do!!!).

Another information problem involves

362 Ashish Chandra and Gary A. Holt

unproven suggestions. In such cases, the adver-tisement makes claims beyond that which hasbeen scientifically or clinically demonstrated byappropriate research techniques. For example, ifvitamins could accomplish all that what isclaimed in its promotions, we would no longerneed health practitioners. Vitamins DO NOT“give you energy,” nor have they been definitelyshown to prevent heart disease, cancer, aging orthe myriad other problems that many vitaminsupplement companies or salespersons wouldhave us to believe. Indeed, careful clinical studieshave repeatedly demonstrated that people canhave a much more positive impact upon theirhealth via the adoption of healthy life styles (e.g.,adequate sleep, appropriate diets and exercise, nosmoking, limited alcohol consumption), thanthey can with even excessive vitamin intake. Thisis not to suggest that vitamins are without value.Rather, it is to suggest that we are a culture thatis continually attracted to “magic bullets” as anantidote for poor lifestyle choices. Hence, adver-tisers of vitamin supplements should take anactive role in promoting the fact that vitaminsshould not be considered as a treatment of allhealth problems, some of which can be preventedby making proper lifestyle choices. Recently, agovernmental agency clearly stated that some ofthe claims made by some companies regardingvitamins and some other “health products” maybe quite wrong and in fact some of theseproducts may even be harmful to patients if takenwithout proper physician guidance.

Advertisements are frequently guilty of a flawin logic known as the argument from ignorance. Inessence, this is a line of reasoning which suggeststhat “there are no ghosts . . . because I’ve neverseen one” (note that according to this logic, theWashington Monument also does not exist . . .if you have not seen it!). Promoters frequentlyargue that science has failed to disprove theirclaims. Thus, “Vitamin C can prevent thecommon cold, because science has never proventhat it cannot!” Some studies may have suggestedan activity for the product which has not beensubstantiated by subsequent studies. PerhapsVitamin C can impact the onset or duration ofcolds. Yet, truth is truth. It does not requirescience to prove or disprove it. If science has

failed to disprove a claim . . . it does NOT meanthat the claim is valid.

The concept of dualism

Ours is also a society which very much believesin absolute dualism. Accordingly, one is eitherright or wrong. It is a view which accepts onlyabsolute extremes with few “gray areas” inbetween. Thus, if science cannot disprove a claim. . . it must, therefore, exist. In this case, theactual truth probably DOES reflect one premiseor the other. Yet, we are too impatient to waitfor credible proof. In some cases, a theory maybe formulated which proposes why a drug shouldbe able to result in some effect. Yet, appropriatescientific and clinical evidence is clearly lacking.Nonetheless, claims are made based uponwhatever evidence does exist, the theoreticalsuggestions, and the lack of scientific evidence tothe contrary. Invariably, promotions state whatpeople want to hear, and certainly, whatever isnecessary to guarantee sales.

Many health professionals have voicedconcerns about the quality of promotionalpractices, since advertisements rarely provideinformation regarding warnings and precautions.Not every drug product is appropriate for everyconsumer. Yet, this fact is traditionally de-emphasized. Since advertisements attempt tocreate a demand for products, it is often theo-rized that consumers might ignore warnings andprecautions even if they were included. Manytimes it is assumed by manufacturers that if theyhave all the “legally relevant” information in thepackage insert of an OTC product the consumerswill read it. However, anecdotally, not all con-sumers read this information as carefully as it isintended to be read. It has also been observedthat quite often warning statements are printedin labels of prescription medication bottles. In arelated study, the authors found that most ofthese warnings statements were printed, usinglaser printer, between font size 3 (approx. 48characters per inch) font size 4 (approx. 40 char-acters per inch). The normal font size used inletter is at least 12 (approx. 12 characters perinch). This might be the reason that only slightly

Pharmaceutical Advertisements 363

more than half of the participants of that studyindicated that they had actually seen warningstatements on the label (Chandra, 1996).

Another major category of advertising problemsinvolves costs. Advertising is expensive. It hasbeen estimated that as much as 50% of the costof some products are related to advertising costs!The more a product is advertised, the moreexpensive it will usually be for consumers. Thereis no doubt in the fact that advertising, particu-larly television advertising, does have an impacton sales of the promoter’s product(s), and mostoften it is positive. This positive impact is alsoone of the reasons of increasing advertising costs.Lets take the example of advertising expensesduring the Super Bowl. People often find out vianews media the amount of advertising fee beingpaid by companies for a 30 second spot ontelevision (it has been observed that most televi-sion ads are 30 seconds long). Thus, the highadvertising fee for a short time period restrictspromoters to include the amount of informationthey can provide in a small duration of time.Obviously, manufacturers must recover theiradvertising expenses, so the product costs mustoffset this expense. Thus, highly promoted painmedications are often far more expensive thanaspirin products that are not so heavily adver-tised. The consumer can reach a point of dimin-ishing return whereby the purchase price farexceeds the benefits actually derived from thepurchase (at least as compared to similar productswhich are available).

A third category of advertising problems involvesbehavioral changes. Because advertisements areoccasionally misleading, they may encourageconsumers to misuse drug products or to makepoor product selections. They may alsoencourage self-care at a time when a health careprofessional should be consulted (e.g., the pro-motion of OTC analgesics for arthritis).

Advertising can encourage consumers to makeunhealthy health care decisions. For example, awell known laxative manufacturer has at timespromoted the idea that “everyone needs a littlehelp now and then!” Yet, laxative products areamong the most misused of all OTC products(usually based on a cultural misconceptionregarding “normal” bowel habits) (Poe and

Holloway, 1980). Stimulant laxatives almostinevitably exceed the concept of a “little” helpand should probably NEVER be the first choicein treating constipation. It has only been withinthe last decade or so that a dependency warninghas been included on product labeling for theseproducts (there are many elderly in our societywho are now physically dependent upon stimu-lant laxatives!).

Anecdotally, deaths have resulted from highprotein diets during the time that they werebeing actively promoted; many patients died fromcancer when they opted for alternative OTCproducts instead of seeking the services of aphysician; and smoking has remained a majorcause of illness and death in our society, despitemore than 25 years of warnings by the SurgeonGeneral. Almost 400,000 Americans die prema-turely each year from the direct or indirect effectsof smoking (Mayo Clinic – How Hazardous isSmoking?, 1993).

Need for a realistic perspective

The previous discussion is not meant to suggestthat all advertising is bad. It does mean thatadvertisements must be considered for what theyare – promotions . . . not a source of factualconsumer information. Some characteristics of an“ideal” drug advertisement is that they beconcise, educational and truthful (Day, 1976). Toachieve these would be difficult at best. Manypromotion practices, as discussed earlier, havevery real space or time limitations. Thus, it isvery difficult to design an advertisement thatcould achieve these characteristics within theconstraints imposed upon them. Yet, these traitsremain as valid guides for promotional practices,as well as for the assessment of promotionalpractices.

Realistically, most consumers are NOT suffi-ciently informed to assess the accuracy or truthof an advertisement. This is particularly impor-tant considering the fact that approximately18.9% of the U.S. population of age 18 and olderhave not completed a high school education(Digest of Educational Statistics, 1996). Holt etal. conducted a study regarding the readability

364 Ashish Chandra and Gary A. Holt

level of 21 “popular” OTC product labels usingtwo readability formulas (G. A. Holt et al., 1990).These formulas used word length, word com-plexity and sentence lengths to compute thegrade in school to which the passage difficultycorresponded. This study found that consumersneeded at least a seventh grade reading ability inorder to follow the instructions of most of theOTC drug products reviewed. Thus, it becomesimportant for health professionals to continuallymonitor advertisements in an effort to be awareof the cultural messages to which consumers arebeing exposed. Only then the health care pro-fessional will be able to identify the importantinformation which is missing from the adver-tisement about which the consumer should beaware. This will also provide the basis for patientcounseling regarding the appropriate assessmentof products because as consumers become moreenlightened, they begin to question more theadvertising practices and are more likely to seekadvice from health professionals as needed.

Advertisements, at times, tend to encourageconsumers to evaluate products based upon actualneed. For example, one popular cold productboasts that it “helps relieve 12 cold symptoms.”This seems impressive until one realizes thatpatients rarely have all 12 cold symptoms at onetime, and 6 out of the 12 symptoms can quiteoften be relieved by the aspirin contained in theproduct (which the consumer probably alreadyhas at home, but is now purchasing again!). Theconsumer is encouraged to purchase ingredientsto treat symptoms that do not actually exist!Pharmaceutical promotional practices oftenprovide little information to assist consumers inselecting specific products for specific symptoms.

Advertisements are at times written by expertsin sales promotion and marketing, not by expertsin health. The messages that clutter our billboardsand airwaves promote wishful thinking, dissatis-faction with self (as we presently exist), and mostimportantly . . . sales. The dilemma of drugmanufacturers is that there are relatively fewdrugs for any disease category which have beenreleased for self-care use and many of the drugswhich are currently available as an OTC productare really not as impressive as similar prescrip-tion drug products. And, since many companies

manufacture OTC products, it is extremelydifficult for a company to have a unique producton the market for very long. The result is that itcontributes to the problems associated withpromotional practices as manufacturers try tomake their products appear to be more uniquethrough unrealistic drug advertisements.

Advertisements tend not to promote theintelligent selection and use of OTC products(which would, in turn, promote responsiblepractices with prescription products, as well).Consumers often purchase more expensiveproducts when less expensive products work justas well (Day, 1976). They may purchase productswith multiple ingredients (thereby exposingthemselves to additional adverse drug reactions,including drug interaction), when only a singleingredient was actually indicated and needed.They may be encouraged to ignore the adviceof health professionals, particularly consideringthe fact of how expensive it is for consumers tovisit health care provider, when the advertisementis providing desirable information. The miscon-ceptions created by irresponsible advertisingpractices can be difficult to remove from thecultural mind-set, especially when the objectiveinformation and advice provided by healthprofessionals is less sensational, and generallyspeaking, not what the consumer wants to hear.Social marketing should be used to improve thehealth of public (Walsh et al., 1993). It is theopinion of the authors of this article that drugmarketers should always try to follow theunwritten rules of marketing ethics and considerwhat is best for their consumers before devel-oping a particular advertising strategy. Increasedparticipation of health care professionals indeveloping these strategies are likely going to bebeneficial to all parties involved which aredirectly and even indirectly associated with thepromotion of drug products.

References

Chandra, Ashish: 1996, ‘Consumer Perceptions andBeliefs as Related to Professional Communicationand Counseling by Pharmacists’, Dissertation,Northeast Louisiana University, Monroe, LA, 115.

Pharmaceutical Advertisements 365

Cope, James D.: 1976, ‘The Charges Against OTCMedicine Advertising – Are They Deserved?’,Journal of the American Pharmaceutical AssociationNS16(9), 500–504.

Day, Robert L.: 1976, ‘. . . Up to Eight Hours ofRelief . . .’, Journal of the American PharmaceuticalAssociation NS16(9), 496–499, 504.

Digest of Educational Statistics, National Center forEducational Statistics: 1996, U.S. Department ofEducation, pp. 218.

Griffenhagen, George B.: 1976, ‘Can OTCAdvertising be Justified?’, Journal of the AmericanPharmaceutical Association NS16(9), 495.

Handbook of Nonprescription Drugs: 1993. AmericanPharmaceutical Association, 10th ed., pp. 1–9.

Holt, Gary A., J. D. Hollon, S. E. Hughes and R.Coyle: 1990, ‘OTC Labels: Can Consumers Readand Understand Them?’, American Pharmacy NS30(November), 51–54.

Kotler, Philip and Gary Anderson: 1997, Marketing:An Introduction, 4th ed. (Prentice Hall, UpperSaddle River, NJ).

Madhavan, S.: 1993 (winter), ‘Are We Ready forDirect-to-Consumer Advertising of PrescriptionDrugs?’, Pharmacy Business, 14(5).

Mathieu, Mark: 1990, New Product Development: ARegulatory Overview (PAREXEL InternationalCorporation, Cambridge, MA), p. 240.

Mayo Clinic: Family Health Book: 1993 (IVIPublishing Inc.).

Morris, L. A. and L. G. Millstein: 1984, ‘DrugAdvertising to Consumers: Effects of Formats for

Magazine and Television Advertisements’, FoodDrug Cosmetic Law Journal 39, 497–503.

Poe, W. D. and D. A. Holloway: 1980, Drugs and theAged (McGraw-Hill, New York, NY), pp. 39–40.

Rheinstein, Peter H. and M. B. Mazis: 1976,‘Regulation of OTC Drug Advertising: The FDA“Prescription”’, Journal of the AmericanPharmaceutical Association NS16(9), 505.

Shuler, J.: 1984, ‘Liz Moench: Taking Boots Directlyto Consumers’, Pharmaceutical Executive 4(September), 22–25, 28, 32, 34, 36, 38.

Waldholz, Michael R.: 1992, ‘Prescription DrugAdvertising: A Critic’s Perspective’, Promotion ofPharmaceuticals: Issues, Trends, Option, 43–52.

Walsh, D. C., R. E. Rudd, B. A. Moeykens and T.M. Moloney: 1993, ‘Social Marketing for PublicHealth’, Health Affairs 12(2), 104–119.

Ashish Chandra,College of Pharmacy,

Xavier University of Louisiana,7325 Palmetto Street,

New Orleans, LA 70125,E-mail: achandra@mail.xula.edu.

Gary A. Holt,Division of Social and Administrative Sciences,

School of Pharmacy and Health Sciences,Northeast Louisiana University,

Monroe, LA 71209.

366 Ashish Chandra and Gary A. Holt